Provider Demographics
NPI:1831280403
Name:POWERS, LEIGH GAYLE (DNP)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:GAYLE
Last Name:POWERS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:LEIGH
Other - Middle Name:POWERS
Other - Last Name:GUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:4400 E HIGHWAY 20 STE 313
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7700
Mailing Address - Country:US
Mailing Address - Phone:850-797-2598
Mailing Address - Fax:773-492-8765
Practice Address - Street 1:4400 E HIGHWAY 20 STE 313
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-7700
Practice Address - Country:US
Practice Address - Phone:507-972-5988
Practice Address - Fax:773-492-8765
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144049163W00000X
TN10692363LP0808X
FLARNP9376651363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509937Medicaid
FL011145400Medicaid
TN3648214Medicare ID - Type Unspecified